APGO

Sarah B. Krantz
The George Washington University School of Medicine and Health Sciences, Washington, DC

Study Objective: An estimated one in six women experiences sexual assault in her lifetime, with prevalence rates in some groups as high as 34%. Survivors are at increased risk for substance abuse, depression, post-traumatic stress disorder, chronic pelvic pain, and other somatic sequelae. Despite the reproductive health implications, little research exists regarding the role of the obstetrician/gynecologist (OB/GYN) in the survivor’s recovery process. While immediate post-assault care has been examined, there is a dearth of information regarding the long-term role of physicians caring for these women. Formal education on the provision of care to this population is frequently not included in OB/GYN residency curricula. Through a survey of OB/GYN Residency Directors, we examined the current state of residency education regarding reproductive care for survivors of sexual assault.

Methods: Institutional IRB approval was obtained. Residency program websites were used to obtain email addresses for OB/GYN Program Directors (PDs) listed on the ACOG website. A short survey of programs’ practices and curricula regarding the care of survivors of sexual assault was sent to 183 PDs using SurveyMonkey. Four subsequent reminder emails were sent. All results were recorded anonymously and analyzed using the SurveyMonkey tool.

Results: The survey achieved a response rate of 23%, which is consistent with general response trends of non-incentivized online surveys. Seventy percent (n=30) of respondents were Directors of university-based programs with 30% (n=13) from community programs. While ninety-one percent (n=39) of programs train their residents to ask patients about their sexual assault history, twenty-one percent (n=9) of programs do not include information about patients’ experiences as victims of sexual abuse or trauma as a standard part of their medical record. In addition, 54% (n=23) of programs do not have any formal didactic sessions focusing on the provision of reproductive care for survivors of sexual assault.

Conclusions: Over half of all OB/GYN residency programs fail to address the ongoing reproductive care of survivors of sexual assault through dedicated curricula. Several programs described educational content limited to lectures addressing post-assault care and forensic nursing. Since many of these sessions omit ongoing care of survivors, the number of programs adequately addressing this issue is likely lower than the 46% found in this study. Over fifteen percent of women are survivors of sexual assault. More research is needed to examine the long-term reproductive health needs of this underserved population, along with the role of the OB/GYN in providing compassionate and sensitive care. We are developing a didactic curriculum to facilitate resident education in this area. Our approach, utilizing traditional didactics as well as case discussion and standardized patients, will incorporate lessons learned from survivors and surveys of PDs, residents and students. We plan to pilot and assess this curriculum at GWU.

Keywords: Assault, rape, residency education